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BackgroundBlood donated by healthy people is extremely important as it is integral in emergent situations. The authors aimed to address and highlight the main causes of the wastage of donated blood and its components. MethodologyA cross-sectional study was conducted at a blood bank of a tertiary care center between January 2019 and March 2020. All the information regarding blood donated and blood components during the study period was documented on a predefined proforma. The blood bags which were seropositive, reached their shelf-life expiry, expired due to non-utilization, or quantity was non-sufficient were discarded. Blood showing any changes of either hemolysis or turbidity was also discarded. Other reasons for discarding blood units included leakage (damage to or fault in the blood bag), hemolytic reasons, or miscellaneous reasons. ResultsA total of 9308 blood donations were received as donations during the study period. Out of the total donations, 7,988 (85.8%) were subjected for component formation including red cell component (RCC), fresh frozen plasma (FFP), and platelets. A total of 23,964 components were prepared using the donated blood. Out of these 2128 (8.87%) units were discarded. Upon stratifying the discarded blood according to the type of component, it was found that platelets made up 1148 (53.9%) units, red cell component composed 324 (15.2%) units, and fresh frozen plasma composed 313 (14.7%) units of discarded blood. Seropositive was reported to be 32.3%. Of this, the red cell component made up 276 (85.2%) units. ConclusionThe present study reported a discard rate of 8.87%. Of these, the majority was composed of platelets due to the shortest shelf life. Leakage of blood bags remained a predominant cause for the discard of blood components. Seropositivity for hepatitis B, C, and human immunodeficiency virus (HIV) was reported in almost 30% units of donated blood. Further large-scale studies should be conducted to reassess how wastage of donated blood can be minimized.

Abstract Objective: To analyse the common causes of death in paediatric acute myeloid leukaemia cases at a tertiary care facility. Methods: The retrospective study was conducted at the Paediatric Oncology Department of the Combined Military Hospital, Rawalpindi, Pakistan, and comprised newly-registered cases of acute myeloid leukaemia aged <18 years from January 1, 2012, onwards and who completed their treatment before January 31, 2019. Data was retrieved from medical records and was analysed using SPSS 23. Results: Of the 206 cases, 130(63.1%) were males and 76(36.9%) were females. Overall mean age at diagnosis was 5.96±3.57 years (range: 9 months to 15 years). Of the total, 6(2.9%) patients died before the start of treatment. Of the remaining, 43(21.5%) patients died during 1st induction chemotherapy, and 16(8%) during the post-induction period, with overall treatment-related mortality being 65(31.5%). The main cause of death during the first two weeks of induction was infection, while infection followed by multi-organ failure was the main cause of mortality in the second phase. A total of 130(63%) patients completed the treatment. Overall survival was 81(62.3%) while disease-free survival was 77 (59.2%). Conclusions: Overall treatment-related mortality rate in paediatric acute myeloid leukaemia cases was found to be high. Key Words: Paediatric acute myeloid leukaemia, Mortality, Infection, Bleeding, Pakistan. Continuous...

Pediatric high-grade glioma (pHGG) is highly malignant central nervous system tumor and constitute 10% of the pediatric gliomas. Effective treatment needs a functioning multi-disciplinary team including pediatric neuro oncologist, neurosurgeon, neuroradiologist, neuropathologist and radiation oncologist. Despite surgical resection, radiotherapy and chemotherapy, most HGG will recur resulting in early death. A significant proportion of HGG occurs in context of cancer predisposition syndromes like Constitutional Mismatch Repair Deficiency (CMMRD) also known as Biallelic Mismatch Repair Deficiency (bMMRD) characterized by high mutational burden. The incidence of HGG with CMMRD is one per million patients. bMMRD is caused by homozygous germline mutations in one of the four Mis Match Repair (MMR) genes (PMS2, MLH1, MSH2, and MSH6). The use of TMZ is now avoided in CMMRD related HGG due to its limited response and known ability to increase the accumulation of somatic mutations in these patients, increasing the risk of secondary tumors. HGG should be managed under the care of multidisciplinary team to receive optimum treatment. This is particularly important for low middle-income countries (LMIC) with limited resources like Pakistan. doi: https://doi.org/10.12669/pjms.39.5.6300 How to cite this: Bashir F, Qureshi BM, Minhas K, Tabori U, Bouffet E, Hawkins C, et al. Pakistan National Guidelines for Pediatric High-Grade Gliomas. Pak J Med Sci. 2023;39(5):---------. doi: https://doi.org/10.12669/pjms.39.5.6300 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To document the demographics and treatment outcome of Paediatric Acute Myeloid Leukaemia (AML) at a tertiary care facility of Pakistan. Methods: The prospective descriptive study conducted at the Paediatric Oncology department, Combined Military Hospital (CMH) Rawalpindi, Pakistan. All newly registered cases of AML under eighteen years of age from 1 st January 2012 onwards who completed their treatment before 30 th September 2018 were included. Results: Data of 187 cases of De novo AML, including 117 (62.6 %) males and 70 (37.4 %) females was analysed. The mean age was 6.1 ± 3.53 years. The most common presenting features were pallor 156 (83.4%), fever 143 (76.5%) & bruising/bleeding 95 (50.8 %). Sixty-six (35.3 %) patients had WBC >50x10 9 /L at presentation. The most common FAB subtype was M-2 in 85 (45.5 %), followed by M-4 in 25 (13.4 %) cases. The overall treatment related mortality (TRM) was 55/187 (29.4%). The major causes of TRM were neutropenic sepsis and bleeding. Sixty patients had refractory or relapsed disease and 53 (88.3%) of them also died. Total 121 patients completed full treatment. OS and DFS of these 121 patients were 65.3 % and 59.5% respectively. Conclusions: This is the largest study of Paediatric AML from Pakistan. High TRM, primarily during induction chemotherapy and relapsed/refractory disease are the major causes of treatment failure. AML-M2 has the best survival rates. Malnutrition, high WBC counts at presentation and unfavourable cytogenetics have decreased OS and DFS rates. Use of Etoposide during induction chemotherapy does not give any survival advantage.

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